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Brett Martindale, Sports Medicine Physician at Ogden Clinic, talks about “tennis elbow” – the causes, symptoms, and how to treat it.
What is “tennis elbow?”
There are several muscles on the back of the hand and forearm that all combine into the single tendon that attaches to the bump on the outside of the elbow. When that tendon is overused or strained, it can cause inflammation in the tendon – tendinitis, or “tennis elbow.”
Is tennis elbow confined to tennis players?
Not at all. In fact, the vast majority of tennis elbow patients I’ve seen say they’ve never played tennis in their lives. Tennis elbow is an extremely common injury in construction workers, chefs, painters and assembly-line workers. I’ve also seen it in stay-at-home moms, presumably developed from chasing and lifting their children. I’d say 3-5% of people will deal with tennis elbow at one point or another in their lifetime.
What are the symptoms?
Tennis elbow really can be a debilitating injury. It causes sharp pain on the outside of the forearm that can often shoot all the way out to the wrist and hand. These symptoms will flare while doing normal everyday things – turning a doorknob, lifting a suitcase, picking up a bucket – anything that requires a slight extension of the wrist.
How can tennis elbow be treated?
Tennis elbow, at its core, starts as a simple inflammatory process. If you catch it early enough and take proper action, it will get better. Remember “R.I.C.E.”:
- Rest – stop doing the activity that gave you the symptoms, and try not to do any activities that will strain your wrist or forearm
- Ice – use ice packs and take anti-inflammatory medications (like ibuprofen) to decrease swelling
- Compression – an adjustable band can be placed around the forearm to help further reduce swelling
- Elevation – keeping the affected forearm above your heart will help reduce swelling even more
Can tennis elbow ever evolve into something worse?
Absolutely, that’s the danger. If you allow your tendinitis to continue to flare up, and you never allow your tendon the rest it needs to get better, the problem will evolve into what we call “tendinosis” – damage to the tendon at the cellular level.
Tendinosis is not an inflammatory process. Instead, the result of your body trying to put ineffective scar tissue into the tendon. This scar tissue does not add strength to the tendon; it doesn’t help provide support in any way – it just takes up space and actually puts more strain on the tendon. Probably worst of all, this scar tissue attracts ineffective blood vessels and nerves to itself, which ends up causing more and more pain in the area. At that point, that problematic excess scar tissue will need to be removed.
What are treatments for tendinitis?
Of course, the best way to remove that tissue is to get your own body to do it for you. This can be accomplished through simply extended rest. Unfortunately, this method is impractical. People need to go to work and live life, so it’s not really possible for folks to entirely avoid using their afflicted arm for several weeks at a time.
Second, you can opt for steroid injections. This will reduce pain and inflammation in the area. However, as we’ve discussed, it’s not really the inflammation that’s the problem – it’s the excess scar tissue. So I personally view steroid shots as a “Band-Aid®” on the problem. I generally encourage my patients not to choose that option.
The third option is physical therapy. Your physical therapist can walk you through exercises and stretches that will help. Your physical therapist can also perform some aggressive manual techniques in which they will help break up that scar tissue and make it easier for your body to carry that problematic scar tissue away. In my experience, I’ve seen about 70-80% of patients heal their elbow tendinosis with physical therapy alone. It’s a great option.
The fourth option is to place a nitroglycerin patch on the affected area. This patch will increase new, healthy blood flow to that area to “remind” your body how to heal the tendon damage correctly. When combined with physical therapy, nitroglycerin patches are especially effective.
A more invasive option is the use of platelet-rich plasma (PRP) injections. During this procedure, a small portion of the patient’s blood is drawn and centrifuged. The activated platelets are then injected into the tendon, releasing growth factors that increase the proliferation of reparative cells. The patient’s own blood is used for this procedure, so I feel that it is tremendously safe. It has proven to be effective when these other options have not worked well enough.
Finally, other procedures can be attempted in those who fail all of the above treatments, such as a procedure called a “tenotomy,” wherein an attempt is made to break up and remove the scar tissue with a special needle. There are also surgical options in the rare case that these treatments are ineffective.